Maternal 24-h movement patterns across pregnancy and postpartum: The LIFE-Moms consortium.

Objective: Time spent among the 24-h movement behaviors (physical activity [PA], sleep, sedentary behavior [SB]) in the perinatal period is important for maternal and child health. We described changes to 24-h movement behaviors and behavior guideline attainment during pregnancy and postpartum and identified correlates of behavior changes. Methods: This secondary data analysis included the standard of care group (n = 439) from the U.S.-based Lifestyle Interventions For Expectant Moms (LIFE-Moms) consortium, including persons with overweight and obesity. Wrist-worn accelerometry was used to measure movement behaviors early (9-15 weeks) and late (35-36 weeks) pregnancy, and âˆ¼ 1-year postpartum. Sleep and moderate-to-vigorous PA (MVPA) were compared to adult and pregnancy-specific guidelines, respectively. SB was classified into quartiles. PA and SB context were quantified using questionnaires. Mixed models were used to examine changes in behaviors and guidelines and identify correlates. Results: Participants were 31.3 ± 3.5 years, 53.5 % were Black or Hispanic, and 45.1 % had overweight. Sleep duration decreased across time, but participants consistently met the guideline (range: 85.0-93.6 %). SB increased during pregnancy and decreased postpartum, while light PA and MVPA followed the inverse pattern. Participants met slightly fewer guidelines late pregnancy (1.2 ± 0.7 guidelines) but more postpartum (1.7 ± 0.8 guidelines) than early pregnancy (1.4 ± 0.8 guidelines). Black or Hispanic race/ethnicity, higher pregravid body mass index, and non-day work-shift (e.g., night-shift) were identified correlates of lower guideline adherence and varying PA and SB context. Conclusion: Perinatal interventions should consider strategies to prevent SB increase and sustain MVPA to promote guideline adherence.

New parents' sleep, movement, health, and well-being across the postpartum period.

OBJECTIVE: The aim of this study was to examine changes and the bi-directional relationship in sleep and movement, and health and well-being among new parents and differences by sex. METHODS: This secondary data analysis included both conditions from a randomized control trial to improve new parents'physical activity [PA] and recruited couples. Parents (n = 181, 117 couples represented 31.5 ± 4.4 years, 51.3% women, 83.3% White) completed questionnaires on regular overnight sleep duration, PA, mental health (perceived stress), physical health (physical quality of life [PQoL]), and well-being (life satisfaction) at 2-, 4-, 6-, and 8-month postpartum. Random-intercept cross-lagged panel models were stratified by sex to examine changes in sleep and PA with health and well-being across time. RESULTS: Sleep and stress were interrelated at different times for fathers (2 months), and mothers (8 months). Sleep and PQoL improved across time, with mothers reporting less sleep than fathers at 4 and 6 months. PQoL at 4 months was related to MVPA at 6-months. Life satisfaction and PA at 2 months was related to PA at 4 months. CONCLUSION: Mothers and fathers experienced different sleep and stress trajectories. Mental health improved postpartum with early connections to PA. Supporting the 24-hour movement behavior cycle and mental health across the parenthood transition may benefit couples.

2024 Adult Compendium of Physical Activities: A third update of the energy costs of human activities.

BACKGROUND: The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity (PA) across studies. The original version was updated in 2000, and again in 2011, and has been widely used to support PA research, practice, and public health guidelines. METHODS: This 2024 update was tailored for adults 19-59 years of age by removing data from those ≥60 years. Using a systematic review and supplementary searches, we identified new activities and their associated measured metabolic equivalent (MET) values (using indirect calorimetry) published since 2011. We replaced estimated METs with measured values when possible. RESULTS: We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers. We added 303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults. We added a Major Heading (Video Games). The 2024 Adult Compendium includes 1114 PAs (912 with measured and 202 with estimated values) across 22 Major Headings. CONCLUSION: This comprehensive update and refinement led to the creation of The 2024 Adult Compendium, which has utility across research, public health, education, and healthcare domains, as well as in the development of consumer health technologies. The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.

Older Adult Compendium of Physical Activities: Energy costs of human activities in adults aged 60 and older.

PURPOSE: To describe the development of a Compendium for estimating the energy costs of activities in adults ≥60 years (OA Compendium). METHODS: Physical activities (PAs) and their metabolic equivalent of task (MET) values were obtained from a systematic search of studies published in 4 sport and exercise databases (PubMed, Embase, SPORTDiscus (EBSCOhost), and Scopus) and a review of articles included in the 2011 Adult Compendium that measured PA in older adults. MET values were computed as the oxygen cost (VO2, mL/kg/min) during PA divided by 2.7 mL/kg/min (MET60+) to account for the lower resting metabolic rate in older adults. RESULTS: We identified 68 articles and extracted energy expenditure data on 427 PAs. From these, we derived 99 unique Specific Activity codes with corresponding MET60+ values for older adults. We developed a website to present the OA Compendium MET60+ values: https://pacompendium.com. CONCLUSION: The OA Compendium uses data collected from adults ≥60 years for more accurate estimation of the energy cost of PAs in older adults. It is an accessible resource that will allow researchers, educators, and practitioners to find MET60+ values for older adults for use in PA research and practice.

Adolescent Diet Quality, Cardiometabolic Risk, and Adiposity: A Prospective Cohort.

OBJECTIVE: Examine the prospective association among diet with adolescent cardiometabolic risk (CMR) and anthropometrics. METHODS: Secondary analysis of an observational study of adolescents aged 10-16 years. Twenty-four-hour food recalls were used to calculate Healthy Eating Index-2015 (HEI-2015) scores. Anthropometrics were assessed using magnetic resonance imaging, dual-energy x-ray absorptiometry, and height/weight measurements. CMR included mean arterial pressure, homeostatic model assessment for insulin resistance, high-density lipoprotein cholesterol, and triglycerides. Associations between HEI-2015 score at baseline with follow-up adiposity and CMR were examined using regression models. RESULTS: A total of 192 adolescents were included. Baseline HEI-2015 scores were inversely associated with follow-up total CMR z-score (P = 0.01), homeostatic model assessment for insulin resistance (P < 0.01), waist circumference z-score (P = 0.02), body mass index percentile (P = 0.01), fat mass (P = 0.04), lean mass (P = 0.02), and visceral adipose tissue mass (P = 0.01). CONCLUSIONS AND IMPLICATIONS: Adolescents with lower adherence to dietary guidelines and greater CMR and anthropometry measurements at baseline continued this trajectory across the observation.

Temporal Changes in Energy-Balance Behaviors and Home Factors in Adolescents with Normal Weight and Those with Overweight or Obesity.

This study aimed to examine the temporal changes in energy-balance behaviors and home factors in adolescents with normal weight and those with overweight or obesity (OWOB). Adolescents or parent proxies completed survey assessments two to four years before (T0; n=82), ≤ six months before (T1; n=68), and ≤ three months after the COVID-19 pandemic outbreak (T2; n=82), to capture energy-balance behaviors (i.e., physical activity [PA], screen time, sleep) and home factors (i.e., food environment, food worry, parent support for PA). At T0 and T1 (before pandemic), participants visited our laboratory for anthropometric measurements. At T2, parent proxies also completed a survey to report the COVID-19 pandemic exposure and impact. The participating families experienced moderate levels of pandemic exposure and impact, although exposure was higher in the OWOB group F1,78=5.50,p<.05. Repeated-measure multivariate analyses of covariance (RM-MACOVAs) did not show significant time by weight status interaction effects (p>0.05; adjusted for race and sex). However, the models detected significant time (T0 vs. T2) by race (White vs. non-White) interaction effect λ7,66=0.81,p<0.05, with greater increase in food worry F1,72=4.36,p<.05 but less increase in screen time F1,72=4.54,p<.05 among the non-White group. Graphical visualization depicted some favorable change patterns in adolescents with normal weight (vs. those with OWOB) for certain behaviors and home factors (e.g., number of days per week ≥ 60 mins PA, food worry). These findings suggest that the COVID-19 pandemic exerted greater adverse effects on adolescents with OWOB and specifically on screen time and food worry among non-White adolescents.

"Weight loss is my goal and being healthy is my goal I can get over the hot flashes": a qualitative exploration of menopausal transition experiences and preferences for weight management among White women.

OBJECTIVES: A qualitative research study design was used to (1) describe experiences of White women during the menopausal transition, and (2) identify barriers and facilitators for participating in a lifestyle program targeting weight management. METHODS: Perimenopausal and postmenopausal White women who self-reported a desire to lose or maintain weight participated in focus groups. Women were queried about their past diet, exercise, and weight management practices; menopausal transition; and specific components and considerations for developing a lifestyle program for weight management. Thematic analysis was conducted on coded transcripts and four main themes emerged, each containing three to six subthemes. RESULTS: Twenty-eight White women (age 54 ± 3 y, body mass index 31.4 ± 9.5 kg/m 2 ) were enrolled. Overall, women felt menopause was a major life event that coincided with weight gain and frustrating body changes. Women already engaged in many different types of exercises and diets to lose weight. Women also talked to healthcare professionals about menopause but were disappointed in the support they received. Women were interested in a lifestyle program that included menopause-specific education, which focused on results beyond weight, which was flexible to their busy lifestyle, and which provided opportunities to build camaraderie among other women experiencing menopause. CONCLUSIONS: This cohort of White women were interested in receiving menopause information and improving their overall health as part of a lifestyle program targeting weight management during this transition. Building camaraderie with other women affected by menopause is important to women, as is creating a lifestyle program that is flexible with daily life.

Painted playgrounds for preschoolers' physical activity and fundamental motor skill improvement: a randomized controlled pilot trial of effectiveness.

BACKGROUND: Preschool children are not meeting recommended levels of physical activity (PA) nor are they proficient in fundamental motor skills (FMS), which are the foundation for PA. As such, interventions are needed to increase PA and FMS in young children. This trial examined the effects of an environmental ("painted playgrounds") and capacity-building (written toolkit) intervention on child FMS, PA, and sedentary behavior at early childhood education (ECE) centers and examined feasibility. METHODS: In a randomized controlled trial, four ECE centers were randomly assigned to an intervention group or wait-list control. For intervention centers, stencils were spray painted adjacent to playgrounds and teachers were provided material for using stencils for FMS practice. Follow-up assessments were conducted six to eight weeks after baseline. Time spent in PA and sedentary behavior was assessed via accelerometry and FMS were evaluated using the Test of Gross Motor Development (TGMD-3) at baseline and follow-up. A repeated measures linear model was performed to test the effects of the painted playgrounds on the primary outcomes of interest. Feasibility was measured by stencil engagement via direct observation and satisfaction surveys. RESULTS: A total of 51 preschoolers completed baseline assessments (4.3±0.6 years; 43.1% male). There were no significant changes in PA or sedentary behavior (all confidence intervals contain 0) between control and intervention groups. Intervention children significantly improved ball skill, locomotor, and overall TGMD-3 percentile scores at follow-up (all (all confidence intervals contain 0), which was not observed in control group. However, there was no significant change in FMS between the control and intervention groups (confidence intervals contain 0). For stencil use, boys and girls interacted with different stencils during their free play. Directors and teachers reported children incorporated academic concepts and initiated games, and teachers prompted more PA opportunities on the playground. CONCLUSIONS: This intervention did not show statistically significant changes in children's PA, FMS, or sedentary behavior compared to a control group; however, small FMS improvements for the intervention group were found from baseline to follow-up. Further work should examine intervention fidelity as well as inexpensive supplies, teacher training, or other strategies to increase preschool children's PA and improve FMS at ECE centers.

Trends in Gestational Weight Gain in Louisiana, March 2019 to March 2022.

Importance: Average gestational weight gain (GWG) increased during the COVID-19 pandemic, but it is not known whether this trend has continued. Objective: To examine patterns of GWG during the COVID-19 pandemic by delivery and conception timing through the second year of the pandemic. Design, Setting, and Participants: This cohort study is a retrospective review of birth certificate and delivery records from 2019 to 2022. Electronic health records were from the largest delivery hospital in Louisiana. Participants included all individuals giving birth from March 2019 to March 2022. Data analysis was performed from October 2022 to July 2023. Exposure: Delivery date (cross-sectionally) and conception before the pandemic (March 2019 to March 2020) and during the peak pandemic (March 2020 to March 2021) and late pandemic (March 2021 to March 2022). Main Outcomes and Measures: The primary outcome was GWG (total GWG and adherence to the 2009 Institute of Medicine recommendations) analyzed using linear and log-linear regression with control for covariates. Results: Among 23 012 total deliveries (8763 Black individuals [38.1%]; 11 774 White individuals [51.2%]; mean [SD] maternal age, 28.9 [5.6] years), 3182 individuals (42.0%) exceeded the recommended weight gain in the year proceeding the pandemic, 3400 (45.4%) exceeded recommendations during the peak pandemic, and 3273 (44.0%) exceeded recommendations in the late pandemic. Compared with those who delivered before the pandemic (reference), participants had higher total GWG if they delivered peak or late pandemic (adjusted ß [SE], 0.38 [0.12] kg vs 0.19 [0.12] kg; P = .007). When cohorts were defined by conception date, participants who conceived before the pandemic but delivered after the pandemic started had higher GWG compared with those whose entire pregnancy occurred before the pandemic (adjusted ß [SE], 0.51 [0.16] kg). GWG was lower in the pregnancies conceived after the pandemic started and the late pandemic (adjusted ß [SE], 0.29 [0.12] kg vs 0.003 [0.14] kg; P = .003) but these participants began pregnancy at a slightly higher weight. Examining mean GWG month by month suggested a small decrease for March 2020, followed by increased mean GWG for the following year. Individuals with 2 pregnancies (1289 individuals) were less likely to gain weight above the recommended guidelines compared with their prepandemic pregnancy, but this association was attenuated after adjustment. Conclusions and Relevance: In this cohort, individuals with critical time points of their pregnancy during the COVID-19 pandemic gained more weight compared with the previous year. The increased GWG leveled off as the pandemic progressed but individuals were slightly heavier beginning pregnancy.

Policy, systems, and environmental interventions addressing physical activity in early childhood education settings: A systematic review.

Policy, systems, and environmental (PSE) approaches can facilitate physical activity in priority populations (e.g., racial and ethnic minority, low wealth groups) within early childhood education (ECE) settings. The purpose of this review was to 1) characterize the inclusion of priority populations within ECE physical activity interventions containing PSE approaches and 2) identify and describe interventions within these populations. Seven databases were systematically searched (January 2000-Febrary 2022) for ECE-based interventions focusing on children (0-6 years) that utilized at least one PSE approach. Eligible studies included a child physical activity or physical activity environment outcome and child or center-level population characteristics. Forty-four studies, representing 42 interventions were identified. For Aim 1, half of interventions included one PSE approach (21/42), with only 11/42 including three or more approaches. Physical environment changes [e.g., adding play equipment, modifying space (25/42)] were the most used PSE approaches followed by system [e.g., integrating activity into routines, (21/42)] and policy [e.g., outdoor time (20/42)] approaches. Nearly half of interventions were conducted in predominantly priority populations (18/42). Studies were primarily rated as good (51%) or fair (38%) methodological quality using the Downs and Black checklist. In Aim 2, of the 12 interventions assessing child physical activity in priority populations, 9/12 reported at least one physical activity outcome in the expected direction. Of the 11 interventions assessing the physical activity environment, 9/11 reported an effect in the expected direction. Findings indicate clear opportunities exist to target priority populations by incorporating PSE approaches in ECE physical activity interventions.

Validation of remote assessment of preschool children's anthropometrics and motor skills.

Introduction: Remotely delivered treatment and research procedures were rapidly adopted in response to the COVID-19 pandemic. However, it is unclear if these measures are valid. The purpose of this study was to compare the validity of anthropometry and motor skill proficiency measurements collected in a remote-setting to in-person setting among a sample of children ages 3-4 years. Methods: Child anthropometry and motor skill performance were measured in-person by trained assessors and by parents at home with remote supervision via videoconference by trained assessors. The following measures from the National Institutes of Health Toolbox were collected: anthropometry (height and weight), manual dexterity/manipulation (9-hole pegboard), motor coordination and agility (supine timed up and go), lower body strength (standing long jump), and postural stability (one-leg standing balance). Differences in expert and parent-based measurements were assessed using Bland-Altman plots, paired samples t-tests, and Pearson correlations. Results: A total of n = 14 children completed the assessments. No significant differences were observed between measurement locations for weight and motor skills (p > .05). Remote measurement of height (M = 101.1 cm, SD = 5.40) was significantly greater than in-person measurements (M = 98.2 cm, SD = 5.16); p < .0001. Discussion: Remote measurements of motor skills and weight are valid assessments for researchers and clinicians to utilize in young children. Remote assessment with guidance offers comparable and valid estimates as in-person assessment, potentially offering a solution to resource-constricted barriers in research and access to care. There is an opportunity for researchers to fine-tune remote height and individual-level assessment strategies.

Association between maternal and infant screen time with child growth and development: A longitudinal study.

BACKGROUND: Sedentary screen time is an early, modifiable risk factor for obesity and poor child development. OBJECTIVES: To examine the relationship between maternal and infant screen time with child growth and development. METHODS: Pregnant women were recruited for a cohort study related to maternal and infant development. Screen time was assessed in mothers during pregnancy, and subsequently in children at 3 months, 12 months, and 24 months of age. Child anthropometry was measured, and nuclear magnetic resonance quantified child fat mass. Fat mass index (FMI) was calculated. The Bayley Scales of Infant Development-III were used to assess child development. Linear regression models were used to assess the relationship between screen time and child growth and development, adjusted for covariates and stratified by sex. RESULTS: Mother/child dyads (n = 89) were mainly white (92.1%), and half were boys (52%). Both sexes increased screen time between 12 months and 24 months (ps <0.05). Child screen time was positively associated with FMI and negatively associated with development scores. In adjusted models, screen time was positively associated with FMI in boys, and meeting the screen time guideline was associated with lower FMI in girls. CONCLUSION: Greater infant screen time was related to higher adiposity. Though few relationships emerged, a cautionary approach to screen time early in life may benefit child health.

Associations Between Moderate to Vigorous Physical Activity, Sedentary Behavior, and Depressive Symptomatology in Adolescents: A Prospective Observational Cohort Study.

BACKGROUND: More moderate to vigorous physical activity (MVPA) and less time in sedentary behavior (SB) may protect against poor mental health in adolescence. Depressive symptomatology may also influence adolescents' own MVPA and SB. The aim of this study was to examine the bidirectional relationship between adolescent MVPA, SB, and depressive symptomatology using a longitudinal approach. METHODS: Adolescents (10-16 y) were recruited for a prospective observational cohort. Depressive symptomatology was measured using the Short Mood and Feelings Questionnaire. Accelerometry was used to measure MVPA and SB. Adolescents were classified by meeting the MVPA guideline (≥60 min/d) and quartiles of SB time, with the lowest amount of time in SB compared to others. Bidirectional associations between MVPA, SB, and depressive symptomatology were assessed using mixed-effects regression models. RESULTS: At baseline, adolescents (n = 205) were 12.5 (2.0) years, 54.6% women, 59.1% White, and 34.6% African American. In unadjusted models, adolescents with less baseline time in SB had lower follow-up Short Mood and Feelings Questionnaire scores, and fewer were classified as depressed at follow-up compared to others. After adjustment, adolescents with less baseline time in SB had lower depressive symptomatology at follow-up. CONCLUSIONS: Limiting time spent in SB in adolescence may improve future mental health.

Effect of exercise training on insulin-stimulated glucose disposal: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVE: The effect of exercise training on whole-body insulin sensitivity has not been systematically summarized. We aimed to summarize the data from randomized controlled trials evaluating the effect of exercise training on insulin action, in adults. SUBJECTS: MEDLINE, EMBASE, and CENTRAL databases were searched until January 2021. Randomized controlled trials lasting ≥4 weeks, including adults, and evaluating the effect of exercise on insulin-stimulated glucose disposal measured using the hyperinsulinemic euglycemic clamp, were included. METHODS: Three reviewers extracted summary data from published trials. The primary outcome was insulin-stimulated glucose disposal. Standardized weighted mean differences (SMD) in glucose disposal between intervention and control were compared. The PEDro scale was used to assess risk of bias. RESULTS: We included 25 trials (36 interventions, N = 851). Exercise increased insulin-stimulated glucose disposal relative to control, SMD = 0.52 (95% confidence interval [CI]: 0.39, 0.65; p < 0.001; I2 = 47%) without significantly suppressing hepatic glucose production. In trials without isotopic tracers, exercise increased glucose disposal (SMD = 0.63; 95% CI: 0.48, 0.77; p < 0.001, I2 = 55%). In trials with isotopic tracers, exercise increased glucose disposal only when tracers were added to the exogenous glucose used for clamping (SMD = 0.34; 95% CI: 0.03, 0.66, p = 0.034. I2 = 0%). In a meta-regression model including aerobic exercise, weight change, and tracer technique, only percent weight change explained between trial heterogeneity (ß = 0.069; 95% CI: 0.005, 0.013). The PEDro rating indicated relatively low risk of bias (5.8 ± 0.22). CONCLUSIONS: Exercise training for at least four weeks significantly increases insulin-stimulated glucose disposal. Weight loss maximizes the effect and may be needed to improve hepatic insulin sensitivity. Differences in tracer methodology contribute to divergent outcomes and should be considered when assessing conclusions from research examining the effect of exercise on insulin action. REGISTRATION: PROSPERO (CRD42019124381).

Policy, system, and environmental interventions addressing obesity and diet-related outcomes in early childhood education settings: A systematic review.

Early childhood education (ECE) settings play an important role in child dietary intake and excess weight gain. Policy, systems, and environment (PSE) approaches have potential to reduce disparities in children at higher risk for obesity. The purpose of this review was to (1) characterize the inclusion of populations at higher risk for obesity in ECE interventions and (2) identify effective ECE interventions in these populations. Seven databases were searched for ECE interventions. Intervention characteristics and methodological quality were assessed in 35 articles representing 34 interventions. Interventions identified were mainly a combination of ECE and parent interventions (41%) or stand-alone ECE intervention (29%), with few multisector efforts (23%) or government regulations assessed (5%). Many included policy (70%) or social environment components (61%). For Aim 1, two thirds were conducted in primarily populations at higher risk for obesity (67%). Studies were rated as fair or good methodological quality. For Aim 2, 10 studies demonstrated effectiveness at improving diet or reducing obesity in populations at higher risk for obesity. Most included a longer intervention (i.e., >6 months), multiple PSE components, and formative work. Opportunities to incorporate more PSE components in ECE-based interventions and collaborate with parents and communities are warranted to improve child health.

Association between Sleep, Sedentary Time, Physical Activity, and Adiposity in Adolescents: A Prospective Observational Study.

PURPOSE: This study aimed to examine the effects of substituting sedentary time with sleep or physical activity on adiposity in a longitudinal sample of adolescents. METHODS: Adolescents (10-16 yr) were recruited for a prospective observational cohort. Parents and adolescents reported demographic characteristics and pubertal development. Accelerometry was used to measure sleep, physical activity, and sedentary time. Adiposity was quantified with imaging techniques. Isotemporal substitution modeling was conducted to examine the effect of substituting 10 min of sedentary time with sleep or differing intensities of physical activity. Results were stratified by sex and race and adjusted for covariates. RESULTS: A total of 217 adolescents provided complete measures at both baseline and 2 yr later (58.1% White, 51.8% girls; 12.9 ± 1.9 yr at baseline). Sleep was negatively related to adiposity 2 yr later when considering other movement behaviors, but substituting baseline sedentary time with sleep was not related to future adiposity ( P > 0.05). In boys and non-White adolescents, substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity 2 yr later ( P < 0.05). Substituting sedentary time for moderate- to vigorous-intensity physical activity was not associated with future adiposity. CONCLUSIONS: Substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity in later adolescence in certain groups. Opportunities to promote an adequate balance of sleep, sedentary time, and physical activity in all adolescents are encouraged for optimal development.

mHealth Intervention for Motor Skills: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Children's motor skills are a critical foundation for physical activity. The objective was to determine the effectiveness and feasibility of a mobile app-based intervention delivered to parents to improve preschoolers' motor skills. METHODS: This randomized controlled trial randomly assigned children to : (1) Motor Skills, including instructional lessons, peer modeling videos, behavioral scaffolding, and structured activities or 2) Free Play. Both groups received a 12-week app-based intervention informed by social cognitive theory to deliver 12 hours (12-minutes per day, 5× per week) of instruction. The children were aged 3 to 5 y; parents and children had no mobility impairments. The primary outcome variables were children's motor skills percentile score assessed with the Test of Gross Motor Development, third edition (TGMD-3) at baseline, end-of-intervention (week 12), and follow-up (week 24); and feasibility and acceptability. RESULTS: Seventy-two children (4.0 ± 0.8 y) participated. Between baseline and week 12, children in the Motor Skills condition significantly improved total TGMD-3 percentile (+13.7 Motor Skills vs -5.3 Free Play, P < .01), locomotor skills percentile (+15.5 Motor Skills vs -4.8 Free Play, P < .01), and ball skills percentile (+8.3 Motor Skills vs -7.3 Free Play, P < .01) compared with children in the comparator group. Significant differences were sustained at follow-up (week 24). Adherence did not significantly differ between conditions (71% for Motor Skills; 87% for Free Play). Parents in both arms reported high scores on satisfaction, helpfulness, and ease of use. CONCLUSIONS: Clinicians and educators may encourage parents to enhance their child's motor skills through structured at-home programs.

Thinking inside the box: The future of young children's physical activity and the home environment.

Parrish et al.'s (2021) investigation of caregiver perceptions of preschoolers' physical activity (PA) within the home environment posits important opportunities for public policy to consider space and available opportunities for PA for preschoolers. This study uncovered qualitative themes on preschoolers' PA in the home, referencing the use of indoor and outdoor spaces, adaptations within the home, interplay between space and caregiving, and variability in child's PA. This work sparks a discussion into the current understanding of the home environment for preschooler PA and future research directions. We propose three main areas to bring forward physical activity and public health research, including 1) role of policies and community (e.g., societal norms) on the home environment and child physical activity, 2) reimagination of the home environment beyond the physical components as a complex system, and 3) advanced measurement of child physical activity using modern technology. Merging these new opportunities with past efforts may help design and facilitate healthier PA and movement patterns for preschoolers now and into the future.

Family child care home providers' self-reported nutrition and physical activity practices, self-efficacy, barriers and knowledge: baseline findings from happy healthy homes.

OBJECTIVE: Describe nutrition and physical activity practices, nutrition self-efficacy and barriers and food programme knowledge within Family Child Care Homes (FCCH) and differences by staffing. DESIGN: Baseline, cross-sectional analyses of the Happy Healthy Homes randomised trial (NCT03560050). SETTING: FCCH in Oklahoma, USA. PARTICIPANTS: FCCH providers (n 49, 100 % women, 30·6 % Non-Hispanic Black, 2·0 % Hispanic, 4·1 % American Indian/Alaska Native, 51·0 % Non-Hispanic white, 44·2 ± 14·2 years of age. 53·1 % had additional staff) self-reported nutrition and physical activity practices and policies, nutrition self-efficacy and barriers and food programme knowledge. Differences between providers with and without additional staff were adjusted for multiple comparisons (P < 0·01). RESULTS: The prevalence of meeting all nutrition and physical activity best practices ranged from 0·0-43·8 % to 4·1-16·7 %, respectively. Average nutrition and physical activity scores were 3·2 ± 0·3 and 3·0 ± 0·5 (max 4·0), respectively. Sum nutrition and physical activity scores were 137·5 ± 12·6 (max 172·0) and 48·4 ± 7·5 (max 64·0), respectively. Providers reported high nutrition self-efficacy and few barriers. The majority of providers (73·9-84·7 %) felt that they could meet food programme best practices; however, knowledge of food programme best practices was lower than anticipated (median 63-67 % accuracy). More providers with additional staff had higher self-efficacy in family-style meal service than did those who did not (P = 0·006). CONCLUSIONS: Providers had high self-efficacy in meeting nutrition best practices and reported few barriers. While providers were successfully meeting some individual best practices, few met all. Few differences were observed between FCCH providers with and without additional staff. FCCH providers need additional nutrition training on implementation of best practices.